Biomedical subjects
Publications and source records attributed to J Maher.
A case of thyroid hemiagenesis discovered incidentally in a patient presenting with a thyroglossal duct cyst is reported. Thyroid embryology is briefly reviewed. Various characteristics of thyroid hemiagenesis and thyroglossal duct cysts are explored.
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Antiepileptic drug use was documented before and after temporal lobectomy. Carbamazepine, phenytoin, and clobazam were the most commonly used drugs, both pre- and postoperatively. Preoperatively, polytherapy was used in 78% of patients; at 6 months follow-up, 47%; at 12 months, 18%; and at 24 months, 14%. Preoperatively, monotherapy was used in 20% of patients; at 6 months follow-up, 49%; at 12 months, 55%; and at 24 months, 42%. No medication was used preoperatively by 2% of patients; at 6 months follow-up, 2%; at 12 months, 27%; and at 24 months, 44% (p < 0.001). After 2 years, 53% of patients who were seizure free had stopped taking medication, as had 33% who had some seizures after surgery.
Focal and segmental, but not generalized, myoclonus have been described with human immunodeficiency virus (HIV) infection. We describe three patients with generalized myoclonus and acquired immunodeficiency syndrome (AIDS) dementia complex. In each, myoclonus persisted until death, invariably after a course of a few months. In two patients, myoclonus was elicited by sudden auditory stimuli and resembled a startle response. This form of myoclonus may be subcortical in origin. We suggest that the AIDS dementia complex be included among the causes of myoclonic dementia.
The nucleotide sequence of 1.5 Mb of genomic DNA from Mycobacterium leprae was determined using computer-assisted multiplex sequencing technology. This brings the 2.8-Mb M. leprae genome sequence to approximately 66% completion. The sequences, derived from 43 recombinant cosmids, contain 1046 putative protein-coding genes, 44 repetitive regions, 3 tRNAs, and 15 tRNAs. The gene density of one per 1.4 kb is slightly lower than that of Mycoplasma (1.2 kb). Of the protein coding genes, 44% have significant matches to genes with well-defined functions. Comparison of 1157 M. leprae and 1564 Mycobacterium tuberculosis proteins shows a complex mosaic of homologous genomic blocks with up to 22 adjacent proteins in conserved map order. Matches to known enzymatic, antigenic, membrane, cell wall, cell division, multidrug resistance, and virulence proteins suggest therapeutic and vaccine targets. Unusual features of the M. leprae genome include large polyketide synthase (pks) operons, inteins, and highly fragmented pseudogenes.
As part of a genetic linkage study of febrile convulsions, families with at least four members with the disorder were identified. By applying known principles of human inheritance, possible modes of transmission of febrile convulsions and factors which might impede progress in understanding their inheritance were analyzed. In eight families, 75 of 333 members had febrile convulsions. Inheritance of the disorder occurred in 43, 51, and 46% of children, siblings and all first-degree relatives of probands respectively. Vertical transmission occurred through three to four generations, including from male to male. In these families with multiple affected members, the findings support an autosomal dominant mode of inheritance of febrile convulsions.
We have previously defined the lipopolysaccharide (LPS)-responsive element (LRE) in the promoters of murine RANTES (regulated on activation normal T-cell expressed) (MuRantes) and murine IP-10/crg-2, chemokines which have potent chemotactic properties for inflammatory cells including monocytes and T lymphocytes. In the present work, we studied the transcriptional mechanism of MuRantes gene induction by virus and compared it with that of LPS in an effort to understand the host responses to virus and bacterial toxins at the molecular level. MuRantes mRNA expression is induced by Newcastle disease virus (NDV) and LPS in the RAW 264.7 macrophage cell line and peritoneal macrophages of LPS-responsive C3HeB/FeJ mice. In LPS-hyporesponsive C3H/HeJ mice, only NDV induces this chemokine gene, indicating that the pathways of transcriptional activation by NDV and LPS are not identical. Using a transient transfection assay, the minimal virus-responsive element (VRE) was localized between nt -175 and -116. The VRE contains previously defined LRE motif 1 (TCAYRCTT) and motif 3 ((T/A)GRTTTCA(G/C)TTT), which were shown to also be important for initiation of transcription by virus. NDV-stimulated nuclear extracts were tested for trans-activating factors able to bind the VRE. The chromosomal protein HMG-I(C) was shown to bind the 3'-A.T-rich domains of the VRE, and the presence of HMG-I(C) was demonstrated in the VRE-protein complex formed with nuclear extracts from NDV-stimulated, but not unstimulated cells. These findings demonstrate the role of HMG-I(C) in activation of MuRantes promoter by NDV.
For many cancer patients and their families the experience of cancer is an intensely stressful one. Emotional support is important for most cancer patients during their illness and can be gained from different people and services. This study evaluates patients' attitudes to different sources of support and rates their satisfaction with sources already used. A total of 431 patients completed a questionnaire covering the use of different sources, including individuals, support groups and information sources. The questionnaire also incorporated validated measurements of anxiety, depression and locus of control. The results revealed that the three most important sources of emotional support were senior registrars (73%) and family (73%), followed by consultants (63%). Patients would prefer doctor- and nurse-led support groups to patient only-led groups (26% vs 12%). Pamphlets, such as the BACUP booklets, proved the most important of the informational sources sought (50%). A total of 86% of patients were satisfied or very satisfied with the emotional support received. Patients who expressed dissatisfaction with their emotional support were significantly more likely to be anxious and depressed (P < 0.001). Patients who used information sources were more likely to have a higher locus of control over the course of their disease. These results show how important the doctor's role is in the provision of emotional support.
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The ras gene products play a fundamental role in signal transduction in haemopoiesis. In this study, we have examined the effects of ras upon haemopoietic cell proliferation and differentiation, using two human cell lines which represent different stages of haemopoietic cell maturation. When a mutant H12-ras gene (codon 12: gly-->asp) was expressed in the monoblastic cell line, U937, marked inhibition of growth was seen together with morphological, functional and immunophenotypic evidence of monocytic maturation. Infection of U937 cells with a c-myc retrovirus produced similar changes strongly suggesting that Myc plays an important role in this action of Ras. By contrast, expression of H12-ras promoted factor-independent growth of the multipotent cell line, TF-1. Furthermore, mutant ras dramatically enhanced the growth of TF-1 cells in the presence of added GM-CSF or erythropoietin, but did not influence the state of differentiation of these cells. These data clearly indicate that in haemopoietic cells, Ras may promote either proliferation or differentiation depending upon cell type and/or state of maturation.
Although Ras plays a fundamental role in cellular proliferation, differentiation and transformation, clear functional differences between the three major Ras proteins (N-, H- and K-Ras) have not as yet been demonstrated. In this study, chimeric constructs were used to compare directly transformation by N-, H- and K-ras oncogenes. In Rat-2 and NIH3T3 fibroblasts, transformation assays (anchorage independence, focus-formation and growth in 1% FCS) showed that H12-Ras was more transforming than N12-Ras or K12-Ras. By contrast, in the human multipotent haemopoietic cell line, TF-1, N12-Ras exhibited greater biological activity. Northern blotting and protein analyses indicated that these findings were not the result of differences in expression or stability of p21Ras. Using further H-ras/N-ras chimeric constructs, we found that the greater transforming activity of H12-Ras in fibroblasts was not due to the hypervariable-CAAX region, but rather to unique sequences between amino acids 84 and 143. These data demonstrate cell specific differences in the intrinsic transforming potential of N-ras, H-ras and K-ras oncogenes.
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OBJECTIVE: To determine, by retrospective chart analysis, the frequency, type and significance of neuromuscular disorders in patients whose clinical features suggested a neuromuscular cause of failure to wean. BACKGROUND: Failure to wean is a common and difficult problem in critical care units. While a neuromuscular cause may be suspected in some patients, the frequency and type has not been determined utilizing comprehensive electrophysiological studies of limbs and the respiratory system. Such knowledge may aid in patient management and prognosis. METHODS: The clinical setting was a critical care/trauma centre that admits 1500 patients per year, approximately 500 being on ventilators for longer than five days. We analyzed the hospital charts of 40 patients admitted to the unit during three years, whose respiratory assessment suggested a neuromuscular cause for failure to wean from the ventilator. To investigate this possibility, we performed electrophysiological studies of the limbs and also of the respiratory system by phrenic nerve conduction and needle electromyography of the chest wall and diaphragm. The results were compared to 25 healthy controls. RESULTS: 38 of 40 patients (95%) had a neuromuscular disorder: 25--critical illness polyneuropathy, 2--Guillain-Barré syndrome, 4--diabetic and critical illness polyneuropathy, 2--uremic and critical illness polyneuropathy, 10--an abnormality of central drive, 5--unilateral phrenic nerve palsy, 3--a neuromuscular transmission defect, and 5--a primary myopathy. Fifteen (38%) had a combination of disorders. Patients with more severe polyneuropathy took longer to wean, a mean of 136 versus 52 days (p = 0.007). The severity of the polyneuropathy had no effect on mortality. CONCLUSIONS: Electrophysiological studies of limbs and the respiratory system are together valuable in confirming the presence, and identifying the specific type of neuromuscular cause for difficulty in weaning from the ventilator. This information is important in patient management and prognosis.
The association between febrile convulsions and temporal lobe epilepsy is recognized, but is controversial. We attempted to clarify this and to determine which attributes of febrile convulsions were associated with temporal lobe epilepsy. During a study of genetic linkage in febrile convulsions, families with at least four affected members were identified. Clinical features of febrile seizures and EEG findings were compared in those who did and did not develop later afebrile seizures. In six selected families, 59 family members had febrile convulsions. Temporal lobe epilepsy developed in eight of these, whereas only one of 213 family members with no febrile convulsions had temporal lobe epilepsy (P < 0.0001). The mean durations of febrile convulsions in those with and without progression to temporal lobe epilepsy were 100 and 9 min, respectively (P = 0.02). Five patients had temporal lobectomies, which revealed mesial temporal sclerosis in all cases. Four patients who developed other types of epilepsy had a mean duration of febrile convulsions of 90 min. The total number, the maximum number in any one day, and the age at onset of febrile convulsions did not differ significantly between groups. Only two patients had neurological deficits, both of whom subsequently had nonlocalizable partial epilepsy. In these families, selected to reduce genetic and phenotypic heterogeneity, a strong association was evident between febrile convulsions and temporal lobe epilepsy with mesial temporal sclerosis. A prolonged febrile convulsion was the most important determinant of this association.
The EEG in childhood epilepsy with occipital paroxysms (CEOP) was termed "distinctive" by Gastaut (1985) and Talwar et al. (1992) and "characteristic" by Herranz Tanarro et al. (1984), which suggests that the EEG is specific and diagnostic for CEOP. However, this hypothesis has been challenged (Newton and Aicardi, 1983; Beaumanoir and Grandjean, 1987). To test this, we reviewed 5,291 EEG reports made in 5 1/2 years in the only tertiary pediatric center in Newfoundland and Labrador. We identified 31 children who had one or more EEGs with occipital spike/sharp waves showing suppression of discharges with eye opening and normal background activity. Six had CEOP, 17 had benign nocturnal childhood occipital epilepsy, 5 had symptomatic epilepsy, 3 had unusual complex partial seizures (CPS), 4 had only provoked seizures, and 2 had no definite seizures. Overlap between seizure types was common. The EEG criteria for CEOP are not very specific.
The MARSEPH program, named for the two principal program collaborators--the Marillac Social Center and Saint Joseph Health Centers and Hospital--provides life and work skills to homeless men who visit a day shelter operated by the Marillac Social Center. Participants gain work experience at Saint Joseph. One of the most important aspects of the MARSEPH program is the removal of obstacles to the newly employed. Each MARSEPH participant receives housing assistance, a uniform, transportation to Saint Joseph Health Centers and Hospital, and a meal pass to the hospital's cafeteria. Through this assistance, the men can get off the streets, get to their jobs, be nourished, and look presentable. The MARSEPH program carefully monitors each participant's progress, to ensure his success. Case workers meet weekly with the men to discuss problems and concerns. Every week case workers also visit each participant's residence to monitor his living conditions and offer emotional support. At the end of the six-month training program, MARSEPH helps graduates find employment.
Retrovirus-mediated gene transfer into human hematopoietic progenitor cells for therapeutic or experimental purposes has proved difficult due to low and variable infection efficiency. To address this, we have developed an in vitro system for the selection and maintenance of a highly-enriched population of retrovirus-infected hematopoietic progenitor cells. Human umbilical cord CD34+ cells were cultured on SNL, a neo-containing murine fibroblast cell line used for embryonic stem cell culture. SNL-supported CD34+ cultures could be maintained with continuing blast cell and CFU-GM production for eight weeks, compared to four weeks in the absence of SNL. We then tested the ability of SNL to facilitate the selection in G418 of CD34+ cord cells infected with the neo-containing retrovirus, vsn-2. While all cells in the control cultures died within 14 days, vsn-2-infected CD34+ cells continued to proliferate, differentiate and produce CFU-GM for up to five weeks after infection. 100% of individually-plucked CFU-GM from such cultures were shown by PCR to be successfully infected. This approach should be useful for experimental work and, since it would diminish competitive repopulation between infected and uninfected progenitors, may also be utilized, with modification, for optimizing gene therapy protocols.
We previously reported that M-CSF could mimic the synergistic effect of SCF upon myeloid FDC-P1 cells that were first infected with a c-fms retrovirus, which encodes the human M-CSFr. We now report that an M-CSFr with a mutation of its autophosphorylation site at position 809 was, in response to M-CSF, unable both to synergize with IL-3 or GM-CSF and to induce c-myc; whereas a mutant receptor with a deletion of its kinase insert was unaffected for these processes. The expression of an exogenous c-myc proto-oncogene or a 12H-ras oncogene lowered the requirement of FDC-P1 cells for IL-3 or GM-CSF, in a similar manner to M-CSF or SCF addition. Furthermore, the expression of either of these genes complemented the defective M-CSFr F809. These results strongly support a role for ras and myc in the synergistic action of M-CSF and, by implication, of SCF, which implies that these signalling intermediates are rate-limiting for the action of IL-3 and GM-CSF and possibly other haemopoietic growth factors.